Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Neuroprotective effect of PRL against glutamate-induced excitotoxicity. Cell viability was assessed by the Syto-13 and propidium iodide (PI) assay and mitochondrial activity was assessed by the MTT reduction assay.

<p>Cell cultures were treated with PRL or Glu alone, or both PRL (10 ng/mL for 72 h) and Glu (100 μM for 24 h). (<b>A</b>) Representative images from neurons stained with Syto-13 (green) and PI (red) in cultures exposed to the different treatments: <b><i>a-c</i>,</b> Vehicle (saline solution). <b><i>d-f</i>,</b> PRL (10 ng/mL). <b><i>g-i</i>,</b> PRL/Glu (10ng/mL and100 μM respectively), <b><i>j-l</i>,</b> Glu (100 μM). White arrows indicate red condensed nuclei indicative of dead cells. (<b>B</b>) Values are the mean ± SD (n = 4 independent experiments). (<b>C</b>) Mitochondrial activity was assessed by MTT reduction. (<b>D</b>) LDH activity in medium culture expressed by the Δ Abs at 340nm. Data were analyzed by one-way ANOVA followed by a Tukey´s post hoc test *<i>p</i><0.05 vs Glu, **<i>p</i><0.001 vs Glu. Scale bar = 100 μm.</p

Effect of PRL on [Ca²⁺]i in a cultured of hippocampal rat neurons.

<p>(<b>A</b>) Control, neurons stimulated with PRL (10 ng/mL for 6 min). (<b>B</b>) Neurons stimulated with Glu (100 μM for 5 min). (<b>C</b>) Neurons pretreated with PRL (10 ng/mL for 72 h) and then exposed to Glu (100 μM for 6 min). Each recording of [Ca2+]i represents an independent experiment. (<b>D</b>) Bars represent the mean ± SD [Ca²⁺]i from 4–9 independent experiments. Data were analyzed by one-way ANOVA followed by Tukey´s post hoc test.** <i>p</i><0.01 versus Glu.</p

PRL prevented procaspase-3 cleavage in hippocampal neurons exposed to Glu.

<p>(<b>A</b>) Results from Western blot and densitometry analyses are expressed as the relative ratio of cleaved caspase-3/GAPDH. Bars represent the mean ± SD from 4 independent experiments. Data were analyzed by one-way ANOVA followed by Tukey´s post hoc test. ** <i>p</i><0.01 <i>vs</i> Glu. Control (Saline Solution; Ctrl), PRL (10 ng/mL), PRL/Glu (10 ng/mL and 100 μM, respectively), Glu (100 μM), rat uterus in estrous (ERU).</p

Prolactin-induced neuroprotection against glutamate excitotoxicity is mediated by the reduction of [Ca²⁺]i overload and NF-κB activation

<div><p>Prolactin (PRL) is a peptidic hormone that displays pleiotropic functions in the organism including different actions in the brain. PRL exerts a neuroprotective effect against excitotoxicity produced by glutamate (Glu) or kainic acid in both <i>in vitro</i> and <i>in vivo</i> models. It is well known that Glu excitotoxicity causes cell death through apoptotic or necrotic pathways due to intracellular calcium ([Ca²⁺] i) overload. Therefore, the aim of the present study was to assess the molecular mechanisms by which PRL maintains cellular viability of primary cultures of rat hippocampal neurons exposed to Glu excitotoxicity. We determined cell viability by monitoring mitochondrial activity and using fluorescent markers for viable and dead cells. The intracellular calcium level was determined by a fluorometric assay and proteins involved in the apoptotic pathway were determined by immunoblot. Our results demonstrated that PRL afforded neuroprotection against Glu excitotoxicity, as evidenced by a decrease in propidium iodide staining and by the decrease of the LDH activity. In addition, the MTT assay shows that PRL maintains normal mitochondrial activity even in neurons exposed to Glu. Furthermore, the Glu-induced intracellular [Ca²⁺]i overload was attenuated by PRL. These data correlate with the reduction found in the level of active caspase-3 and the pro-apoptotic ratio (Bax/Bcl-2). Concomitantly, PRL elicited the nuclear translocation of the transcriptional factor NF-κB, which was detected by immunofluorescence and confocal microscopy. To our knowledge, this is the first report demonstrating that PRL prevents Glu excitotoxicity by a mechanism involving the restoration of the intracellular calcium homeostasis and mitochondrial activity, as well as an anti-apoptotic action possibly mediated by the activity of NF-κB. Overall, the current results suggest that PRL could be of potential therapeutic advantage in the treatment of neurodegenerative diseases.</p></div

Proposed molecular mechanisms involved in the PRL-mediated neuroprotective effect against Glu-induce excitotoxicity in primary cultures of rat hippocampal neurons, which includes.

<p><b>a)</b> Regulation of [Ca²⁺]i homeostasis, <b>b)</b> NF-κB activation and the <b>c)</b> Concomitant overexpression of anti-apoptotic proteins. Question marks and dotted lines indicate hypothetical relationships.</p

PRL induced NF-κB activation in hippocampal neurons. Nuclear translocation of NF-κB was assessed by immunochemistry.

<p>Cell cultures were exposed to PRL (10 ng/mL for 72 h) and Glu (100 μM for 24 h), or were treated with PRL or Glu alone. Representative photomicrographs from primary cultures of rat hippocampal neurons: <b><i>a-d</i>,</b> Vehicle. <b><i>e-h</i>,</b> PRL (10 ng/mL). <b><i>i-l</i>,</b> PRL/Glu (10ng/mL and 100 μM respectively), <b><i>m-p</i>,</b> Glu (100 μM). Cytoskeleton was stained green with Phalloidin 488: nuclei were stained blue with Hoechst and in NF-κB protein was labeled in red. White arrows indicate nuclear translocation of NF-κB. Scale bar = 24.08 μm.</p

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures